Many lethal-injection executions are bungled

THE BALTIMORE SUN

TIMOTHY J. McVEIGH is sentenced to die by lethal injection at 7 a.m. May 16 in Terre Haute, Ind., for the role he played in the Oklahoma City federal building bombing. Edward Brunner, M.D., Ph.D., is the Eckenhoff professor and chairman emeritus of anesthesia at Northwestern University Medical School and at Northwestern Memorial Hospital. A death penalty opponent, he was a practicing anesthesiologist for four decades. The following is an edited interview done by Charles M. Madigan of the Chicago Tribune:

Q Is lethal injection a painless way to die?

A Not necessarily. It may be, but more often than not it is messed up. It is misused in its application because the people who use the drugs for lethal injection don't understand the mode of action or the time course over which the drugs act.

Q Describe what happens during a lethal injection.

A Three drugs are used. The first one is sodium thiopental, an ultrashort-acting drug. It acts within a minute to make the brain unconscious. From that point on it begins to wear off. Depending on the dosage, the individual may wake up within three or four minutes. The second drug is called succinylcholine. It acts at the point where the nerves enervate the muscles, and it causes an overstimulation of the muscle so you get muscle twitching all over the body. The muscles are then completely flaccid and unable to move. This drug will act for about 10 minutes, but if given in much larger doses it can act longer. The final drug that is used is called potassium chloride. We use that drug to stop the heart beating when we are doing heart surgery and in lethal injection it is used to stop the heart beating, never to start again.

Q What can go wrong in lethal injections?

A In misuse of the drugs, the thiopental will cause the patient to look like he is falling asleep. The second drug will paralyze him. If the drugs are not given properly, the sleep drug can wear off, allowing the patient to be aware but unable to move, even to breathe. He undergoes suffocation and asphyxiation in a horribly painful way, even though he looks completely calm as he is lying on the table. Then he experiences that deep burning sensation as the potassium courses through his veins on the way to his heart.

Q How often are mistakes made?

A We know that in about 40 percent of cases where lethal injection has been used, there has been misuse in one way or another, and it has taken as long as 45 minutes for the person to die. The problem is they tried to make this a very sterile kind of a procedure, but no matter how you dress it up, you are still killing someone.

Q What can go wrong technically?

A The chemistry of the drugs is such that thiopental and succinylcholine, when they react to each other, cause a precipitation of a white, flaky substance that will block up the needle from the IV. What has happened in a number of cases is that they give the thiopental and follow with the succinylcholine, then they get this precipitate which blocks the needle. The thiopental wears off. The patient is partly paralyzed and partly not, and begins to move around. In a number of circumstances, they have to close the curtains so that people can't see the struggling. Sometimes they have to start all over again. It is not a clean process because the people who are using the drugs aren't trained to use them.

Q Why can't doctors administer the drugs?

A Every medical society has looked at the problem, at this issue - the American Medical Association, the American College of Surgeons, the American College of Physicians and the American College of Pathologists. The whole spectrum of medical professional groups has condemned the participation of physicians in this process. Doctors are trained to heal, not to kill, and so it is unethical for doctors to participate.

Q So who administers the drugs?

A They turn to people who are untrained and who have no business using these drugs. Thiopental is a controlled substance. To use it you need a special license, which the executioner doesn't have and the warden doesn't have. So they are in violation of federal and state regulations when they use these things. More than that, the drugs have been tested for safety in therapeutic uses. They have never been tested for use in killing people. What they are really doing is experimenting on humans, much like the German doctors did in concentration camps. What they are doing is inhumane. The subjects end up with a strong possibility of being subjected to excruciating suffering.

Q Is there a humane way of killing anyone?

A That is a difficult question to answer. I think from the point of view of my morality, we don't have the right to kill anyone. Technically, leaving morality aside, could I kill someone? Yes. But I have had four years of college, four years of medical school and four or five years of anesthesiologist training. I think I could kill someone in a comfortable and humane way, but I can't do that because of the ethical standards of my practice and because of my own personal ethics. I also have a doctorate in pharmacology, so I have a great depth of knowledge about drugs and their actions.

Q So lethal injection could be every bit as inhumane as other methods of execution, hanging and electrocution, for example?

A That is correct, but it appears that it is not inhumane. It's appearances, not actuality, that we are dealing with. It would be much more humane to shoot somebody, but we have done away with firing squads for some reason. The electrocutions, especially the ones in Florida, where they had fire and flashes of electricity coming out of the heads of the prisoner, were very inhumane.

Q Are you saying lethal injection is more humane for the witnesses than for the person being executed?

A I think that is correct. There is something very strange going on with this Timothy McVeigh execution, where the families of the victims want closure by watching him die. It seems almost as though this is vengeance or retribution that is coming into play here. There is no place for that in human interaction.

Q What do you teach your students in medical ethics about execution, and how do they react?

A We have a course in medical ethics in which I have discussed exactly this issue, in a class where several of the students came from Oklahoma City, and they were very adamant about the need of Timothy McVeigh to die and for the execution to be observed to assure people that there was closure in this whole thing. There is no question that McVeigh is a criminal, and he did something that was absolutely horrible. But because he did something horrible doesn't mean that we are allowed to do something horrible too.

The students react very much as lay people react. Some are strongly opposed to the death penalty. Many of them support the death penalty and would participate, from their point of view as a lay person. But it is important that we teach the ethics of medicine to these people, which says basically, first do no harm. That is a guiding principle in the practice of medicine, to help your patient but never to harm him. You have to recognize that what the criminal justice system is trying to do is to convert this prisoner to a patient, to make him look like he is a patient. He is not a patient. To treat him as a patient is subversion of the role of medicine.

Q Why do you think they do that?

A They do that for the conscience of the people who are watching, for the conscience of the community killing this man or woman: "We will do it in the nicest way possible." There is no nice way to kill somebody. What is awful is that these drugs are designed to help patients. What would happen if a doctor told a patient, "I used these drugs to kill Timothy McVeigh yesterday." That would be awful. The drugs deserve better treatment than to be used to kill.